Day 2 at 5pm - Hypertensive emergency with decreased GCS. Unable to control blood pressure. Sudden unresponsiveness.
Extensive hypodensity now affects both cerebellar hemispheres, pons and brain stem and both occipital lobes. Significant posterior fossa mass effect with effacement of all CSF spaces. Evidence of ascending transtentorial herniation and tonsillar herniation. The calibre of the third and lateral ventricles has increased, with some evidence of CSF seepage. The sulcal CSF spaces of both hemispheres are effaced when compared with previous. The basal cisterns are preserved.
Lacunar infarct in the left corona radiata appears acute. Old right-sided lacunar infarct noted. The remainder of the supratentorial neural parenchyma appears within normal limits.
The optic nerve sheaths have become prominent with early flattening of the optic disks - this reflects raised intracranial pressure.